Workers Comp in Fresno

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Fresno sits in inland California, far from the cool winds of the Pacific Coast. Its population is a fraction of what it might be if it were located a few miles west, with a beach to draw in tourists and residents. Despite all that, the Fresno workers comp court covers a large geographical area, stretching from Bakersfield in the south to Stockton in the north.

These cities are all situated in or around California’s world-famous and heavily fertile Central Valley.

“The population here is not as big as the Bay Area or Southern California,” said Thomas Tusan, a Fresno workers comp attorney with nearly 50 years of experience representing injured workers. “But there’s a lot of agricultural injuries unique to the Central Valley that you don’t see in some of those areas. We have other industries too, but agriculture is the basic industry in the Central Valley.”

Those other industries include retail, manufacturing, and construction. However, agriculture is what puts Fresno on the map. The land surrounding Fresno is as fertile as the banks of the Nile, producing one-fourth of the nation’s food including 40% of all nuts and fruits.

Laborers work tight schedules to ensure produce arrives at the grocery stores fresh. Employers put a lot of pressure on their workers to get the job done, which could lead to some downplaying or outright ignoring injuries they receive at work. It might seem like a good idea to “tough it out,” but doing so could come back and bite you in the long run.

“If the injury is going to leave the worker with a permanent impairment that will adversely affect his/her future work life, then a workers compensation attorney can guide the case towards a result that will lessen the economic impact,” Tusan said.

Reasons to Hire a Workers Comp Lawyer in Fresno

Often, injured workers decide they’re going to power through the injury (potentially exacerbating it) rather than informing their boss, which they fear may put their career at risk. It can be mind-numbing having to put your employer in a corner. However, when your health is on the line, it’s your future – your ability to provide a future – that’s at stake.

You should report workplace injuries right when they occur. Waiting on your employer to get the ball rolling gets you nowhere. The more time that passes after your injury, the harder it becomes to verify what happened. Even if you can recall when and where you were injured, your employer will have little reason to take your complaint seriously.

“A lot of times the employer and the workers comp insurance company are refusing to acknowledge the injury. Maybe the employee doesn’t think it’s significant, and doesn’t report it right away,” Tusan said.

Later, maybe even weeks or months later, the worker struggles to get out of bed or starts limping around the house. That is when the realization sets in. The slip they took at work was more serious than they thought. Unfortunately, they didn’t report it.

“Then you have a factual dispute as to whether the injury occurred at the workplace,” Tusan said.

And receiving benefits for your claim becomes a nasty dispute!

Here are some signs that you need a workers compensation attorney in Fresno:

  • Employer gives you the runaround when you bring up the injury
  • You’re being harassed by medical providers because bills aren’t being paid
  • You have been out of work for more than two weeks because of the injury
  • Your wage compensation checks are late arriving or not the right amount
  • Employer does not provide information on what doctor or clinic to go to for treatment
  • You receive notice from the carrier that they are disputing the claim
  • The insurance carrier denies your claim
  • You aren’t sure if the wage compensation has been accurately calculated
  • There is a dispute as to whether the claim happened at work
  • You haven’t received any wage benefits

What Do Workers Comp Attorneys in Fresno Do?

The California workers comp system treats you differently without an attorney. For example, the type of legal evaluation you undergo can depend on whether or not you have legal representation of your own.

When a worker doesn’t have an attorney, they must have a Qualified Medical Evaluation that is performed by a randomly selected California Qualified Medical Examiner (QME).

When a worker DOES have legal representation, their attorney chooses the doctor who will perform the medical-legal evaluation. The one caveat being that the claims administrator must agree to this choice. However, the difference here is stark. In one instance you have no say in who will evaluate your evidence, and in the other, you have a professional hand-selecting your medical evaluator for you.

This is a big deal because your monetary compensation ultimately comes down to the opinion of your medical evaluator.

“The biggest difference that an attorney can make in the outcome of the case is the choice of the doctor who is going to serve as the medical-legal evaluator,” Tusan said. “An experienced attorney will have the knowledge and resources to identify the best medical-legal evaluator that will maximize the amount of money that will be awarded to the injured worker, as well as assuring that the injured worker is entitled to an award of future medical treatment.”

Here are some ways a workers comp attorney can have a direct impact on your case:

  • Depose doctors involved in the treatment
  • Depose claims adjuster representing insurance company
  • Conference with doctors treating the injury
  • Know the doctors involved. Some are insurance-oriented. Some look out for the patient first. Do you know the doctors well enough to know the difference?
  • Know how to successfully calculate lost wages
  • Conduct settlement negotiations with the insurance carrier
  • Knowing the experts that will testify in support of your claim
  • Know the grounds for appeals, if the case gets that far
  • Handle preparations and meet deadlines leading up to trial
  • Understand other benefits you may be entitled to

How Much Does a Workers Comp Lawyer in Fresno Charge?

Workers compensation attorneys only get paid if they’re able to secure some type of award or compensation on your behalf. This means you don’t have to worry about how you’re going to afford an attorney. You’re only obligated to pay if you get paid yourself.

“Under the California system, the attorney fees are contingent on the attorney’s success in acquiring a financial recovery,” Tusan said. “The fees must be approved by the workers compensation judge who is assigned to the case … the usual fee is 15% of the amount of the permanent disability award.”

Consultation is usually free, which means you can call an attorney to talk about your case before making any commitments. He or she should be upfront as to whether or not they can help you, since they don’t get paid if it turns out there’s nothing they can do to aid your case.

How to Handle a Workers Comp Case on Your Own in Fresno, CA

Most claims do not require the help of a workers comp attorney. When the system works as intended, you simply have to notify your employer to kickstart the process of filing a workers compensation claim. If things do not work out in your favor, you have the option to appeal a claim denial. This will require the help of a workers comp lawyer, but for reference, the step-by-step guide is detailed below.

How to File a Workers Comp Claim in Fresno

Employees injured on the job in Fresno should notify a supervisor immediately to ensure receiving benefits, including medical care. If the injury or illness developed gradually, it should be reported to the employer as soon as you believe it was caused by your job.

To protect your rights, file a claim form as soon as possible. Your employer must give or mail you a claim form within one working day after learning of your injury or illness. The California claim form can be downloaded online. Workers also can contact the Department of Industrial Relations’ Information and Assistance Unit online or by calling 1-800-736-7401.

Once you have the claim form, fill out the “employee” section, sign and date it, and send it to your employer right away. Always keep a copy. The claim form should be returned to the employer in person or by mail. If you mail the claim form, use certified mail (“return receipt requested”) so there is a record of the date it was mailed and received.

Failure to return the completed form to your employer puts you at risk of losing your right to benefits. If your employer does not give you a claim form, contact an information and assistance officer.

Employers Responsibility in Fresno Workers Comp Claims

Employers are responsible for completing the “employer” section of a claims form and forwarding the completed claim form to the insurance company. Employees should receive a copy of the completed claim form from their employer; if you don’t, request a copy and keep it for your records.

Deadlines for Fresno Workers Comp Claims

There are multiple deadlines for all parties a Fresno workers comp case and following them is essential to make sure your claim is processed efficiently.

The most important deadline for injured workers is reporting an injury or illness within 30 days of when you believe it incurred on the job. For most workplace maladies, determining when the injury occurred is simple enough, but repetitive-stress injuries or occupational diseases that occur gradually, can make that determination complicated.

For those cases, the timeline for reporting and filing your workers comp claim starts when the following happen:

  • You first missed work or saw a doctor for the injury or illness
  • You knew or should’ve known that it was caused by your work, generally because the doctor explained that to you.

Once your injury is reported and your completed claim form submitted to the insurance company, your employer must authorize medical treatment for you within one day, to a maximum of $10,000, while your claim is investigated. If that authorization is not provided, you should immediately contact California’s Information and Assistance Unit for help.

When the claim is submitted, the insurer has 14 days in which to mail you a letter with the status of your claim. Contact the insurer if you don’t receive a letter within 14 days.

If your employer does not deny your claim within 90 days, you can presume that your injury is covered. If the injury or illness forces you to miss work, you should begin receiving temporary disability benefits within 14 days after the insurer learns about the injury and your temporary disability. If the insurer doesn’t start the payments by then or respond to the claim by denying it or asking for more information, it will be required to pay a 10% late penalty on the disability payments.

How to Appeal a Claim Denial in Fresno

If your workers comp claim is denied, you can file an appeal with the state Division of Workers Compensation Appeals Board using this form.  After completing the form, you must file it at the Fresno DWC office. You must serve the appeal to all other parties.

Employee Assistance Office

Phone: (559) 445-5051
2550 Mariposa Mall, Suite 4078
Fresno, CA 93721-2219

Directions to the Fresno DWC office:

The DWC office will send you a notice confirming that it has been filed. The notice will include your assigned case number, which will begin with the letters “ADJ” followed by a sequence of numbers. Use the assigned case number on all documents and correspondence.

Next, you must file a Declaration of Readiness to Proceed to request a hearing before a workers compensation administrative law judge. Your case will be scheduled for a hearing called a mandatory settlement conference (MSC). At the hearing, workers will want an experienced workers comp attorney in their corner.

The judge will discuss the case with you and your claims administrator and try to assist the both of you in reaching a settlement. If your case is not settled at the MSC, you will need to prepare documents that outline the dispute, identify the items each party will present at trial and the names of the witnesses that each party will ask to testify.

The trial will be held before another judge, and you will be required to attend. The judge will issue a written decision after the trial and send it to you by mail, usually 30-90 days after the trial. If either you or the claims adjustor disagrees with the judge’s decision, a Petition for Reconsideration can be filed.

If there is a disagreement between you and your claims administrator over the diagnosis of your injury by your treating physician or treatment plan, you most likely will need to request a qualified medical examiner (QME) to review your case and issue a medical-legal opinion. These are doctors that meet additional educational and licensing requirements

If the worker is represented by an attorney, the attorney may try to convince the claims administrator to agree to a doctor to review the case, known as an agreed medical examiner (AME). This can be a quicker more efficient process than a QME.

What to Do If Your Employer Does Not Have Workers Comp Insurance

It is illegal for an employer to run a business in Fresno without carrying workers compensation insurance. Those that fail to do so are subject to steep fines, having their business shut down, criminal charges, and even jail time for the employer.

If you believe your employer is not insured, contact your local Department of Industrial Relations Division of Labor Standards Enforcement (DLSE) office and make a complaint. Go to www.dir.ca.gov/dlse to find a local office.

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About the author

Bill Fay has touched a lot of bases in his 45-year career. He started as a sports writer, gaining national attention for work on college and professional sports. He had regular roles as an analyst on radio and television and later became a speech writer for a government agency. His most recent work is as an internet content marketing specialist. Bill can be reached at bfay@workerscompensationexperts.org.